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Boutsioukis C, Arias-Moliz MT, Chávez de Paz LE. A critical analysis of research methods and experimental models to study irrigants and irrigation systems. Int Endod J 2022; 55 Suppl 2:295-329. [PMID: 35171506 PMCID: PMC9314845 DOI: 10.1111/iej.13710] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-omputed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.
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Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
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Wilkoński W, Jamróz-Wilkońska L, Zapotoczny S, Opiła J, Grandino L. Real-time co-site optical microscopy study on the morphological changes of the dentine's surface after citric acid and sodium hypochlorite: a single-tooth model. BMC Oral Health 2021; 21:454. [PMID: 34535105 PMCID: PMC8449479 DOI: 10.1186/s12903-021-01815-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To this day, the effects of sodium hypochlorite and chelating agents on the smear layer and on the dentine's surface, remain not fully examined. The study is aimed to analyze the dentine's surface treated with 40% citric acid and 5.25% sodium hypochlorite according to two irrigation protocols. MATERIALS AND METHODS The study employed a computer-controlled Nikon Eclipse LV100 optical microscope. Ten roots split longitudinally with canals prepared mechanically using the MTwo system to a size of 40/04 were observed. The root halves were divided into two study groups, one half in each of the groups. According to two irrigation protocols, the dentine's surface was irrigated with 40% citric acid and 5.25% sodium hypochlorite, separated with water. Dentine surface was observed in a fixed place and photographed in 500 × magnification after each irrigation stage. The obtained images were then analyzed using computer software (NIS-Elements AR, GIMP-2.6, ImageJ 1.45s). RESULTS Various speed of removal of the smear layer and varied morphological changes of the dentine's surface were observed in both examined groups. Double irrigation of the dentine with citric acid for 30 s resulted in complete removal of the smear layer, and double irrigation for 60 s resulted in increased mean diameter of the dentine tubules (degradation of the dentine's surface). CONCLUSIONS Double alternating irrigation with citric acid and sodium hypochlorite for 30 s yielded satisfactory results, while double irrigation for 60 s resulted in increased mean diameter of the dentine tubules. A real time assessment of the dentine's surface changes after both tested solutions can improve understanding of the phenomena that occur during the irrigation and as a result it might help to improve clinical outcomes in root canal treatment.
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Affiliation(s)
- Wojciech Wilkoński
- Research Department of the Polish Endodontic Association, Kielce, Poland.
| | | | - Szczepan Zapotoczny
- Faculty of Chemistry of the Jagiellonian University, ul. Gronostajowa 2, 30-387, Kraków, Poland
| | - Janusz Opiła
- Chair of Applied IT of the Faculty of Management of AGH University of Science and Technology, Kraków, Poland
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Elbahary S, Haj-Yahya S, Khawalid M, Tsesis I, Rosen E, Habashi W, Pokhojaev A, Sarig R. Effects of different irrigation protocols on dentin surfaces as revealed through quantitative 3D surface texture analysis. Sci Rep 2020; 10:22073. [PMID: 33328515 DOI: 10.1038/s41598-020-79003-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
The combination of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) has been advocated as an effective irrigation methodology to remove organic and inorganic matter in root canal therapy. Yet, it was suggested that both solutions might lead to structural changes of the dentinal wall surface, depending on the order of application which might affect sealer mechanical retention. This study aims to evaluate the effect of different irrigating protocols on dentin surface roughness using quantitative 3D surface texture analysis. Data stems from 150 human root dentin sections, divided into five groups, each prepared according to one of the following protocols: Negative control; 17% EDTA; 17% EDTA followed by 5.25% NaOCl; 5.25% NaOCl; and 5.25% NaOCl followed by 17% EDTA. Each dentin sample was examined for its three-dimensional surface texture using a high-resolution confocal disc-scanning measuring system. EDTA 17% and the combined EDTA 17% with NaOCl 5.25% showed considerably higher roughness properties compared to the control and to NaOCl 5.25% alone. However, the irrigation sequence did not affect the dentin roughness properties. Therefore, mechanical retention is probably not dependent upon the selection of irrigation protocol sequence.
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Wright PP, Cooper C, Kahler B, Walsh LJ. From an assessment of multiple chelators, clodronate has potential for use in continuous chelation. Int Endod J 2019; 53:122-134. [DOI: 10.1111/iej.13213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- P. P. Wright
- The School of Dentistry The University of Queensland Herston QldAustralia
| | - C. Cooper
- Central Analytical Research Facility (CARF) Institute for Future Environments Queensland University of Technology Brisbane Qld Australia
| | - B. Kahler
- The School of Dentistry The University of Queensland Herston QldAustralia
| | - L. J. Walsh
- The School of Dentistry The University of Queensland Herston QldAustralia
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Deari S, Mohn D, Zehnder M. Dentine decalcification and smear layer removal by different ethylenediaminetetraacetic acid and 1-hydroxyethane-1,1-diphosphonic acid species. Int Endod J 2018; 52:237-243. [PMID: 30030844 DOI: 10.1111/iej.12987] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/18/2018] [Indexed: 12/01/2022]
Abstract
AIM To compare solutions of di- and tetrasodium ethylenediaminetetraacetic acid (EDTA) and 1-hydroxyethane-1,1-diphosphonic acid (HEDP) regarding their ability to solubilize calcium from dentine and remove smear layer. METHODOLOGY Solutions with a molarity corresponding to that of 17% Na2 EDTA (pH adjusted to 8.5) were prepared by dissolving Na2 and Na4 salts of HEDP (etidronate), or Na4 EDTA in deionized water. Standardized root dentine discs covered by a smear layer were prepared from human third molars. These discs (n = 10 per group) were immersed in test solutions or phosphate-buffered saline for 1 min. The dissolved Ca2+ was determined by atomic absorption spectroscopy, apparently opened dentinal tubules by laser scanning microscopy and automated image analysis. Ca2+ values were compared between groups by parametric, tubular areas by nonparametric methods, α = 0.05. RESULTS Solutions prepared from the tetrasodium salts were alkaline (pH 11.3-11.4), whilst counterparts made from the disodium salts were acidic. The EDTA solutions dissolved more calcium than the HEDP counterparts (P < 0.05); solutions prepared with the disodium salts dissolved more calcium than those made from the tetrasodium salts (P < 0.05). There was a high correlation between dissolved calcium and the apparently opened tubular areas (Spearman's ρ = 0.81). Differences between groups regarding opened tubules were similar to those observed regarding the Ca2+ values, with a slightly reduced discerning power due to high variance. CONCLUSION Calcium chelation and thus smear layer removal by EDTA and HEDP are influenced by pH.
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Affiliation(s)
- S Deari
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - D Mohn
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH Zurich, Zurich, Switzerland
| | - M Zehnder
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Yadav HK, Tikku AP, Chandra A, Yadav RK, Patel DK. Efficacy of etidronic acid, BioPure MTAD and SmearClear in removing calcium ions from the root canal: An in vitro study. Eur J Dent 2016; 9:523-528. [PMID: 26929691 PMCID: PMC4745234 DOI: 10.4103/1305-7456.172613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The purpose of this study was to quantify the amount of calcium ions removed from the root canal by etidronic acid (HEBP), BioPure MTAD, and SmearClear using atomic absorption spectrophotometer. MATERIALS AND METHODS Fifty (n = 50) freshly extracted human mandibular premolar teeth were collected and decoronated at the cementoenamel junction. The canals were prepared in a crown down fashion using the rotary system and copiously irrigated with 1.0% sodium hypochlorite. All specimens were rinsed with the deionized water. Based on the type of chelating agent used, the samples (n = 10) were randomly divided into five (four test and one negative control) groups. Accordingly, Group I - 9% HEBP, Group II - 18% HEBP, Group III - SmearClear, Group IV - BioPure MTAD, and Group V - normal Saline. Subsequent to irrigation, the solution was collected in a test tube and subjected to atomic absorption spectrophotometer for the quantification of calcium ions removed from the root canal. RESULTS The mean concentration of calcium ions removed from the root canal (mean ± standard deviation) in all groups (I-V) were 13.32 ± 0.54 μg/ml, 16.36 ± 0.27 μg/ml, 20.04 ± 0.24 μg/ml, 18.15 ± 0.39 μg/ml, and 8.74 ± 0.49 μg/ml, respectively. CONCLUSIONS SmearClear was the most effective agent for the removal of calcium ions from the root canal. Hence, its combined use with an organic solvent can be recommended for efficient smear layer removal.
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Affiliation(s)
- Hemant Kumar Yadav
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - A P Tikku
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Chandra
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Yadav
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Devendra Kumar Patel
- Analytical Chemistry Laboratory, Regulatory Toxicology Group, CSIR- Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India
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De-Deus G, Reis C, Paciornik S. Critical appraisal of published smear layer-removal studies: methodological issues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112:531-543. [PMID: 21696983 DOI: 10.1016/j.tripleo.2011.01.046] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/31/2011] [Indexed: 05/31/2023]
Abstract
The smear layer phenomenon has been extensively addressed over the past 3 decades. However, there still are unanswered questions on this issue and the main responsible factor is the qualitative and nonreproducible character of most in vitro smear layer removal studies. The methodological reasons that led to the current lack of reliable conclusions on procedures aiming to remove the smear layer are comprehensively addressed. The limitations and outcomes related to different assessment methods are discussed as well. General speaking, the results by score-based conventional SEM studies are not trustworthy and reproducible. Computational routines able to automatically extract quantitative data of dentin morphology are necessary to minimize the human bias. An ideal experimental model should have a longitudinal observational character, in which a given dentin area can be observed at different times. The use of flat dentin samples should be avoided because of the influence of gravity as well as root canal anatomy on the final result of the chelating process. The experimental model also needs to take into consideration the amount and distribution of sclerotic dentin and irregular secondary dentin, otherwise the final results can be compromised. Inasmuch as there is a clear lack of scientific standard, simple comparative SEM evaluations are pointless at the present moment. The ideal experimental model to assess smear layer removal is not currently available. Therefore, further research efforts should be directed to the development of and testing of new methodological approaches to be used in the smear layer removal studies. The improvement of the experimental models is a requirement to draw up optimized clinical guidelines for the chemical treatment of the root dentin.
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Qian W, Shen Y, Haapasalo M. Quantitative analysis of the effect of irrigant solution sequences on dentin erosion. J Endod 2011; 37:1437-41. [PMID: 21924198 DOI: 10.1016/j.joen.2011.06.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/05/2011] [Accepted: 06/06/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the study was to examine the level of erosion on root canal wall dentin caused by immersion in different irrigant solutions in alternative sequences. METHODS Dentin specimens from teeth with one root canal were instrumented and randomly divided into five groups. Each group was subjected to 17% EDTA, 17% ethyleneglycoltetraacetic acid (EGTA), or 10% citric acid (CA) and 5.25% sodium hypochlorite (NaOCl) varying the time of irrigant exposure and the order of the irrigants. The specimens were examined by scanning electron microscopy (SEM), and randomized digital images of the dentin surface were taken. The area of tubule openings was measured by a semiautomatic method. RESULTS No erosion was detected when demineralizing agents were used as a final rinse after NaOCl. However, the erosion of peritubular and intertubular dentin was detected when EDTA, EGTA, or CA were used first followed by 5.25% NaOCl (P < .05), and an increase over 100% in the area of dentin tubule openings was measured (P < .01). CONCLUSIONS NaOCl used as a final irrigant solution after demineralization agents causes marked erosion of root canal dentin.
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Affiliation(s)
- Wei Qian
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
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De-Deus G, Reis C, Fidel S, Fidel R, Paciornik S. Dentine demineralization when subjected to EDTA with or without various wetting agents: a co-site digital optical microscopy study. Int Endod J 2008; 41:279-87. [DOI: 10.1111/j.1365-2591.2007.01345.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De-Deus G, Reis C, Fidel S, Fidel RAS, Paciornik S. Longitudinal and quantitative evaluation of dentin demineralization when subjected to EDTA, EDTAC, and citric acid: a co-site digital optical microscopy study. ACTA ACUST UNITED AC 2008; 105:391-7. [DOI: 10.1016/j.tripleo.2007.08.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 08/07/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
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De-Deus G, Zehnder M, Reis C, Fidel S, Fidel RAS, Galan J, Paciornik S. Longitudinal Co-site Optical Microscopy Study on the Chelating Ability of Etidronate and EDTA Using a Comparative Single-tooth Model. J Endod 2008; 34:71-5. [DOI: 10.1016/j.joen.2007.09.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 09/10/2007] [Accepted: 09/24/2007] [Indexed: 11/17/2022]
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De-deus G, Reis C, Fidel S, Fidel R, Paciornik S. Dentin Demineralization When Subjected to BioPure MTAD: A Longitudinal and Quantitative Assessment. J Endod 2007; 33:1364-8. [DOI: 10.1016/j.joen.2007.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 06/22/2007] [Accepted: 07/01/2007] [Indexed: 11/24/2022]
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Marending M, Paqué F, Fischer J, Zehnder M. Impact of Irrigant Sequence on Mechanical Properties of Human Root Dentin. J Endod 2007; 33:1325-8. [PMID: 17963956 DOI: 10.1016/j.joen.2007.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Monika Marending
- Division of Endodontology, Department of Preventive Dentistry, Periodontology, and Cariology, University of Zürich Center for Dental Medicine, Zürich, Switzerland
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